Connecticut assisted living services agency (ALSA) license: DPH rules and steps

Connecticut licenses the care, not the building

In most states, “assisted living” is a licensed building. Connecticut is the exception. A July 2026 Office of Legislative Research report notes that the state auditors called Connecticut the only state that does not comprehensively license assisted living facilities.⁠⁶ Instead, DPH licenses the assisted living services agency (ALSA). An ALSA provides nursing services and help with activities of daily living to people whose condition is “chronic and stable”.⁠¹⁠² The residence is a managed residential community (MRC): private units with a managed group living environment, housing and services for people who are mainly 55 or older.⁠²

This split shapes the whole business:

• The ALSA is an “institution” under CGS 19a-490. No one may operate one without a DPH license (CGS 19a-491(a)).⁠¹
• The MRC does not hold its own license. It does have statutory duties in CGS 19a-694 through 19a-701, plus registration and core-service rules in RCSA 19-13-D105(c).⁠²⁠³ Residents can live in an MRC without using any ALSA services.⁠⁶
• An MRC that wants to offer assisted living must either become licensed as an ALSA itself or arrange with a separately licensed ALSA. If it arranges, it files an application with DPH to do so (CGS 19a-564(a)-(b)).⁠¹
• An ALSA may serve only people who live in an MRC (RCSA 19-13-D105(e)(2)).⁠³ Under the statutory definition, it may also serve an elderly housing complex funded through HUD’s Assisted Living Conversion Program. Such a complex does not have to register as an MRC (CGS 19a-693(2), 19a-564(c)).⁠¹⁠²

According to DPH figures cited by OLR in July 2026, 123 licensed ALSAs serve 142 MRCs.⁠⁶

Is an ALSA the right license for your plan?

Several Connecticut licenses sit close to this one. Choose based on where clients live and what care they need.

• Residential care home. A home that gives room, board and services to two or more unrelated residents is a residential care home. It is a separate DPH license, and the building itself is what gets licensed. See the Connecticut residential care home guide.
• Home health care agency. An ALSA serves a “chronic and stable” population. Skilled care for someone whose condition is no longer chronic and stable belongs to a licensed home health care agency. The ALSA’s registered nurse must bring one in when that happens (RCSA 19-13-D105(h)(3)(G)).⁠³ See the home health care agency guide.
• Homemaker-companion agency. Companion and homemaker services in a private home are registered with the Department of Consumer Protection, not licensed by DPH. See the homemaker-companion registration guide.
• State-funded congregate housing. This is excluded from the MRC definition (CGS 19a-693(4)).⁠² DPH may waive parts of the ALSA regulation, but only for agencies serving state-funded congregate housing (RCSA 19-13-D105(b)(7)).⁠³

There is also a ceiling on need: MRCs may not enter a residency agreement with anyone who needs 24-hour skilled nursing care unless that person has arranged and keeps that care (CGS 19a-698).⁠²

Three ways to set up the business

The rules allow three setups, and each one changes what you file.

1. The MRC operator holds the ALSA license

   One owner runs the housing and the care. The regulation allows shortcuts in this setup. The MRC’s governing authority can serve as the ALSA’s governing authority. Contracts between the ALSA and the community are not required under common ownership. If the agency serves 30 or fewer clients a day, one person can be both supervisor of assisted living services and the MRC’s service coordinator (RCSA 19-13-D105(d)(4)-(5), (j)(9)).⁠³

2. A standalone ALSA contracts with one or more MRCs

   The governing authority must keep a written contract with each MRC. In that contract, the ALSA agrees to monitor whether the community provides core services “on a regular and continual basis”.⁠³ The MRC files with DPH to arrange services with you (CGS 19a-564(b)).⁠¹

3. An ALSA contracts directly with individual tenants

   An agency that contracts with a tenant but not with the community must still comply with the full regulation (RCSA 19-13-D105(e)(3)).⁠³ Residents have a right to use an ALSA that has no formal contract with their MRC (D105(m)(15)).⁠³

What the MRC must have before you serve it

The ALSA license depends on the community. DPH may suspend, revoke or refuse to renew a license if the agency serves an MRC that fails to provide core services. The ALSA itself must stop serving an MRC that fails to provide them (RCSA 19-13-D105(b)(4)-(5)).⁠³ Before signing with a community, check every item below.

MRC filing with DPH

Assisted living services may not start in an MRC until the community has notified DPH and filed the following (RCSA 19-13-D105(c)(1)):⁠³

• evidence of compliance with local zoning, local building codes, and the Connecticut Fire Safety Code and Supplement
• the management company or manager, and the legal owner or operator
• how tenants are told that the MRC is not licensed by DPH
• what tenants are told about available assisted living and home health services and how to see itemized costs
• the person who receives official notices, and the names of the ALSAs
• an attestation that core services are available on a regular and continual basis

DPH must answer within 30 days, saying either that the filing is complete or that it is incorrect or incomplete (D105(c)(2)).⁠³

Core services and building features

Each private residential unit must include a full bathroom and access to food preparation and storage (CGS 19a-693(7)).⁠² Tenants may not be required to share units (D105(c)(7)).⁠³ The MRC must meet the Public Health Code, State Building Code, Fire Safety Code and disability accessibility law (CGS 19a-701).⁠² Only an MRC licensed as an ALSA may provide health services itself, including supervising residents’ self-administered medications (D105(c)(6)).⁠³

No certificate of need

CGS 19a-638(b)(5) lists the assisted living services agency among the providers that do not need a certificate of need.⁠⁵ The 1994 regulation still says a CON, if required, is a prerequisite to licensing (D105(b)(1)), but the statute settles the question.⁠³⁠⁵

The supervisor of assisted living services and staffing

Staffing is the core of what DPH reviews. The governing authority must approve the supervisor and a designee in writing (D105(j)(1)).⁠³

Supervisor qualifications (D105(g)(1)):⁠³ a registered nurse licensed in Connecticut with either

• a bachelor’s degree in nursing and at least 2 years of full-time (or equivalent) clinical nursing experience, or
• a nursing diploma or associate’s degree and at least 4 years of full-time clinical experience within the past 10 years.

In both cases, at least 1 year must be in a home health care agency or a community health program that cared for sick people at home. “Full time” means at least 35 hours a week (D105(a)(11)).⁠³

Connecticut sets no staff-to-resident ratio for ALSAs.⁠⁶ The supervisor is responsible for making sure nurse and aide staffing meets client needs (D105(j)(5), (10)).⁠³ The supervisor also sends the MRC’s service coordinator weekly reports on problems and monthly statistics on clients and services (D105(g)(2)).⁠³ If the supervisor is absent for more than one month, the agency must report it to DPH, and any change of supervisor must be reported immediately (D105(b)(3)(G), (g)(4)).⁠³

Aide and staff training

• Assisted living aides must have completed a Connecticut-approved home health aide training and competency evaluation program. They also need 10 hours of orientation from the supervisor or a designated nurse before any direct care (D105(i)(2)).⁠³
• In-service education for aides must average at least one hour every two months over the year (D105(f)(1)(B)).⁠³
• Dementia training on hire and annually for all direct care staff (CGS 19a-562b).⁠¹
• Retaliation training: from October 1, 2026, all employees need annual in-service training on residents’ fear of retaliation and their right to complain (PA 26-44).⁠⁶
• Personnel policies must cover annual physical examinations with tuberculin testing, annual performance evaluations and written job descriptions (D105(f)(1)).⁠³

Background checks

ALSAs are “long-term care facilities” under Connecticut’s criminal history and patient abuse background search program. Anyone who will have direct access to residents must go through the search before you make a job offer or sign a contract with them. The rule also covers volunteers who will regularly have direct access. Conditional employment can last up to 60 days while the search is processed. A clean search from the past three years can be accepted (CGS 19a-491c).⁠¹

Who you can serve and what aides may do

A physician or other authorized practitioner must decide in writing, at least once a year, that a client’s condition is chronic and stable. That can include chronic and stable mental health and cognitive conditions (D105(e)(7)).⁠³ Since June 7, 2023, an ALSA may keep serving a client who is no longer chronic and stable if the client is under a licensed home health or hospice agency, or the ALSA and MRC are arranging ancillary medical services (CGS 19a-564(g)).⁠¹

A registered nurse must assess each client and write an individualized service plan with the resident. The plan states the scope, frequency and itemized cost of services and is signed by the resident (CGS 19a-699).⁠² RN reassessments happen at least every 120 days (D105(h)(3)(C)).⁠³

Medication rules (D105(h)(4)) are narrow:⁠³

• A licensed nurse may give medications, or pre-pour them for clients who self-administer, under a practitioner’s written order.
• An aide may only remind clients, check that they took their medications, or open packaging for them.
• The RN verifies orders at least every 120 days, and all medications are stored in the client’s own unit.

Aides may help with bathing, dressing, toileting, eating, walking, transfers and household tasks, as assigned by the client’s licensed nurse (D105(i)(3)). An RN must be reachable by phone and available for a home visit whenever aides are working, including nights, weekends and holidays (D105(i)(5)).⁠³

Governance, quality assurance and required policies

The regulation is written for a corporation with a governing board (D105(d)):⁠³

• Governing authority: dated bylaws, at least two meetings a year with signed minutes, an annual budget review, and responsibility for quality.
• Home health contract: a written contract with at least one licensed home health care agency, unless that agency is under common ownership.
• Quality assurance committee (D105(l)): at least one physician, one RN with 2 years of home health experience (or a BSN nurse), and one social worker. None may be an owner, stockholder or employee of the agency or related to one. Employees may sit only as non-voting ex officio members. The committee meets at least every 120 days and reviews a random sample of active and closed records each time. The agency produces an annual QA report.
• On-site office: a designated office at the MRC with space for conferences and supervision and lockable records (D105(e)(4)).
• Written policies: admission criteria that do not screen out clients whose needs the agency can meet, and discharge policies with five set categories (change in condition, routine, emergency, financial, premature). You also need a medical emergency procedure, a complaint procedure and complaint log, and a client bill of rights with 16 required items (D105(e), (m)).
• Records: client service records kept on the MRC campus in a DPH-provided format and retained at least 7 years after discharge or death (D105(k)).

Dementia special care units

A program that locks or separates residents with dementia, or that markets itself as specializing in dementia care, is a dementia special care unit or program (CGS 19a-562).⁠¹ An ALSA running one needs DPH approval and must list each unit and its staffing plan in initial and renewal applications (CGS 19a-564(d)). Residents must get a signed written disclosure covering eight topics, including staffing, physical environment and costs.⁠¹ Licensed staff and aides in the unit need 8 hours of dementia-specific training within 120 days of hire and 8 hours every year after, plus 2 hours of pain-management training a year (CGS 19a-562a).⁠¹

The application, step by step

DPH does not post an ALSA application packet online. The FLIS page tells applicants to request an initial application by email and to submit it there, and its generic forms list has worksheets for home health and homemaker-home health aide agencies but none for ALSAs.⁠⁴ The only published checklist of contents is the regulation’s list in step 4. Ask FLIS ([email protected]) for the current ALSA form and any added attachments before you draft anything.

1. Line up the community. Confirm the MRC’s DPH filing, its core services and its building-code and fire compliance. If you will contract with it, draft the ALSA-MRC contract.⁠³

2. Form the entity and governing authority. Adopt bylaws, appoint the supervisor and designee, and appoint the quality assurance committee.⁠³

3. Request the initial application from [email protected].⁠⁴

4. Assemble the contents required by D105(b)(2)(B):⁠³

   • the list of MRCs you will serve
   • affidavits that you will serve only compliant MRCs and only clients who understand and agree to services and costs
   • employees by category and the services provided
   • a projected two-year budget showing financial viability
   • a certificate of malpractice and public liability insurance
   • a certificate of good standing
   • names of everyone with 10% or more direct or indirect ownership, plus officers and directors
   • your agent for service
   • any health care institutions you own or operate in other states

   FLIS also posts generic supporting forms: ownership forms for LLCs, trusts and corporations, an example certificate of insurance, a local fire marshal’s certificate, long-term care affidavits and an applicant attestation.⁠⁴

5. Pay the fee and file. The 2001 regulation says the application must be notarized. The statute now says DPH applications are not required to be notarized (CGS 19a-491(a)).⁠¹⁠³ DPH may also require a consent order as a condition of licensure.⁠¹

6. Scheduled inspection. DPH issues the initial license after a scheduled inspection finds the applicant meets the requirements (CGS 19a-493(a)).⁠¹ DPH states no processing time.

7. License issued and posted. The license names the licensee, the d/b/a and the locations served. It must be posted in the business office (D105(b)(3)(E)-(F)). DPH notifies the State Long-Term Care Ombudsman within 30 days of licensing (CGS 19a-564a).⁠¹⁠³

Questions on the regulations go to the FLIS contact for home health care, assisted living and homemaker-home health agencies ([email protected]). The DPH main line is 860-509-7400.⁠⁴

Fees and license term

DPH’s biennial licensing and inspection fee for an assisted living services agency is $500 per site, as published on 2026-10-12 (CGS 19a-491(c)(14)). Agencies in the congregate housing facility pilot program under CGS 8-119n are exempt.⁠¹ The license lasts two years or a fraction of two years and ends on the last day of a calendar quarter (CGS 19a-493(a)).⁠¹

Rules on what you charge residents

Connecticut has tightened fee disclosure several times since 2024:

• ALSA fee increases: at least 60 days’ written notice, and the three-year fee history on request. Immediate changes are allowed when a resident’s care needs change (CGS 19a-564(e), PA 24-141).⁠¹
• Increases over 10%: from October 1, 2026, the ALSA must hold an informational hearing at least 30 days before the increase takes effect (PA 26-74, § 1).⁠⁶
• MRC rent and recurring fees: 90 days’ advance notice. If the MRC cannot meet a resident’s needs within the first 45 days, it must refund certain charges (CGS 19a-694(a)(2)-(3)).⁠²
• Residency agreements must be in plain language and at least 14-point type. Agreements signed on or after October 1, 2024 must disclose nonrefundable charges, how and when fees rise, and three years of fee history. A deceased resident’s estate owes at most 15 days after death once the unit is vacated (CGS 19a-700).⁠²
• Client bill of rights: changes in charges must be given orally and in writing at least 15 working days in advance (D105(m)(1)).⁠³

Public funding: the Home Care Program for Elders

Public money for ALSA services comes through the Department of Social Services’ Connecticut Home Care Program for Elders (CHCPE). The program pays for services only, never room and board.⁠⁸ The statute covers assisted living services in state-funded congregate housing and in assisted living pilot or demonstration projects (CGS 17b-342).⁠⁷ DSS lists these settings: state-funded congregate housing, federally funded HUD facilities, four affordable assisted living demonstration sites, and a private assisted living pilot.⁠⁸

• Participants must be 65 or older and eligible for CHCPE. They may owe a 9% cost share or applied income. Services come in four packages, from 1 to 25 hours of personal care a week plus nursing visits as needed.⁠⁸
• Private pay pilot: 125 slots with a waitlist. An Access Agency care manager assesses each participant and sets the service package.⁠⁹ By statute, the two pilots for MRC residents (CGS 17b-365 and 17b-366) are capped at 125 people combined. Both pay for services from DPH-licensed ALSAs.⁠⁷
• Affordable demonstration (CGS 17b-347e): at least three municipalities and up to 300 subsidized units, combining DSS services, Department of Housing rental subsidies and CHFA loans.⁠⁷

DSS’s 2020 draft §1915(c) waiver application says an ALSA must hold the DPH license, that the Department’s fiscal intermediary credentials providers who want to enroll as waiver providers, and that the MMIS contractor and DSS quality assurance staff verify qualifications at Medicaid provider enrollment and every two years after.⁠¹¹ The sources do not publish the enrollment forms or the service package rates. Ask DSS Community Options for the current provider enrollment steps and rates before you count on CHCPE clients.

Renewal, inspections and changes

• Renewal applications are due at least 30 days before expiration (D105(b)(3)(B)) and are filed through the CT eLicense portal.⁠³⁠⁴ DPH renews after an unscheduled inspection and approval of the licensee’s renewal report (CGS 19a-493(a)).⁠¹
• Ownership changes: the license cannot be transferred. A change in ownership of 10% or more of a corporate licensee’s stock needs DPH’s prior approval (D105(b)(3)(D), (H)). Change-of-ownership applications are requested from the same FLIS mailbox.⁠³⁠⁴ The statute separately requires the application for approval at least 120 days before the proposed change (CGS 19a-493(c)(3)), while the regulation says 90 days’ written notice, so plan on the longer period. Changing the legal form without changing beneficial ownership, for example a corporation becoming an LLC, is not a change of ownership if you give DPH the information it asks for (CGS 19a-493(c)(1)(B)).⁠¹⁠³
• Notices to residents: the MRC must give 30 days’ notice before the operator changes or before the ALSA serving the community changes (CGS 19a-564b).⁠¹ The ALSA must give clients 30 days’ written notice before surrendering its license (D105(b)(4)(D)).⁠³

Changes from 2023 to 2026 and what is pending

• 2023: ALSAs may serve residents who are no longer chronic and stable under set conditions (PA 23-31). MRCs offering assisted living must encourage family councils (PA 23-48).⁠¹⁠²
• 2024: new fee-disclosure and refund rules for ALSAs and MRCs (PA 24-141). DPH must notify the Ombudsman of each new ALSA license, and MRCs must give 30 days’ notice of operator or agency changes (PA 24-39).⁠¹⁠²
• 2025: MRCs may hold a restaurant caterer permit to serve alcohol at daily meals and events, effective October 1, 2025 (PA 25-51).⁠¹⁰
• 2026: the informational hearing for fee increases over 10% (PA 26-74) and the retaliation training (PA 26-44) both take effect October 1, 2026. PA 26-72 amended the MRC resident bill of rights.⁠⁶
• Pending: PA 26-13, § 2 requires DPH to form a working group on whether MRCs themselves should be licensed. The commissioner’s report is due February 1, 2027.⁠⁶ If MRC licensing follows, the setup described above would change.

Sources

1. 1
   Connecticut General Assembly, Connecticut General Statutes, chapter 368v (Health Care Institutions) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Connecticut General Assembly, Connecticut General Statutes, chapter 368bb (Managed Residential Communities) Checked 12 Oct 2026 · Back to text ↑
3. 3
   Connecticut Secretary of the State, eRegulations System, Regulations of Connecticut State Agencies, section 19-13-D105 (Assisted living services agency) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Connecticut Department of Public Health, Facility Licensing and Investigations Section (FLIS): Facility Licensing Checked 12 Oct 2026 · Back to text ↑
5. 5
   Connecticut General Assembly, Connecticut General Statutes, chapter 368z (Health Systems Planning; certificate of need) Checked 12 Oct 2026 · Back to text ↑
6. 6
   Connecticut General Assembly, Office of Legislative Research, Assisted Living Facility Regulation (OLR Report 2026-R-0069, July 20, 2026) Checked 12 Oct 2026 · Back to text ↑
7. 7
   Connecticut General Assembly, Connecticut General Statutes, chapter 319y (Programs for elderly persons) Checked 12 Oct 2026 · Back to text ↑
8. 8
   Connecticut Department of Social Services, CT Home Care Program for Elders, Community Options: Assisted Living Services Checked 12 Oct 2026 · Back to text ↑
9. 9
   Connecticut Department of Social Services, Private Pay Assisted Living Program Checked 12 Oct 2026 · Back to text ↑
10. 10
    Connecticut General Assembly, Office of Legislative Research, 2025 Acts Affecting Seniors (OLR Report 2025-R-0098) Checked 12 Oct 2026 · Back to text ↑
11. 11
    Connecticut Department of Social Services, Application for a 1915(c) Home and Community-Based Services Waiver (CT.020.07.00, draft of July 1, 2020) Checked 12 Oct 2026 · Back to text ↑

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